Transcript

Norman Swan: People who oppose immunisation usually do so because of a view of the way doctors and drug companies operate, rather than an assessment of the facts. So concludes a study from the University of Sydney.

The research, which examined arguments run against immunisation in the media, found that conspiracy theories tended to dominate.

The message, says Associate Professor Simon Chapman, who was one of those involved, is that doctors and Governments can't afford to be patronising or arrogant in this debate. They need to be much more tuned into peoples' views rather than thinking the facts alone are going to convince parents who are resisting immunising their children.

Simon Chapman: What we found, looking back over six years of anti-immunisation reportage, was that while there are a great many individual claims being made by anti-immunisations, at the bottom of most of those claims, run a series of what we could call sub-texts: dominant themes which seem to underscore most of those claims. And they're claims like that there is a cover-up going on, that intrepid, investigative anti-immunisation people have been scuttling around in libraries and have come up with all this evidence that doctors have refused to release, therefore these are truth-tellers who are bringing a great deal of information which is of enormous public interest and concern; that there is an unholy alliance for profit between the drug industry, the Government and the medical profession, and that they're all colluding in this to keep all the adverse reactions quiet and so forth. And then there's the messages which are all about that vaccines are essentially evil, they are a product of the chemical industry, you know, the pharmaceutical industry, that they're the modern equivalent of witches' brews, they have all sorts of impurities and so forth in them, and that basically they go against nature.

Norman Swan: Now is this just because people have got their facts wrong, or is it because of a view of the world?

Simon Chapman: I think deep down it's a view of the world in public health and risk communication generally. It's been shown repeatedly that if you're having an argument with somebody about something that they have heartfelt beliefs about, those views are not amenable to change simply to the presentation of facts. It's generally solved by the building of rapport, by people feeling that actually there is care going on between the two parties to the relationship and so forth. Also I'd add an element that there is a sense that people feel alienated from understanding the nature of the world that we live in today, that it's all going far too fast, there are too many mysteries which are unaccounted for and so forth. So there was a big theme running through anti-immunisation reportage, that if you named any disease for which the aetiology was unclear -

Norman Swan: The cause.

Simon Chapman: That's right, something like autism, chronic fatigue syndrome, I mean even criminality, they would say, 'Well, this is related to vaccination in the community.

Norman Swan: But our discussion now could be seen as supremely arrogant and ignoring people's concerns about the world, and who are we to say that they are wrong?

Simon Chapman: My job in this paper was to simply point out that the discourse on anti-immunisation is not a discourse which is fundamentally about Piece of Evidence A, Piece of Evidence B, it's fundamentally a discourse about Them and Us, and Them is very much the medical profession, Governments and so forth.

Norman Swan: Drug companies.

Simon Chapman: Drug companies and so forth, who are all pictured as basically in it for their own self-interest.

Norman Swan: How important is this anti-immunisation view, when it comes to the immunisation problem, of the lack of coverage? Because some people say, 'Look, it's not actually the main reason why people don't have their children immunised. The main reason is that they forget, so doctors don't follow up; it's the system that falls apart rather than people having a deep-seated resistance to it.' Do you find a growing press coverage and any sense of influence on the debate?

Simon Chapman: Well the latest Australian immunisation study looked at a very large sample of parents right around the country, and children, and it basically came up with the fact that 52% of children had their full immunisation, and that is a woeful level and it's been compared to Third World levels. Now if you look for the reasons why the parents haven't got their children immunised, the outstanding reasons were, as you say, the never-got-around-to-it factor, or inconvenience, and I think governments can do an awful lot more to remedy those problems. But disturbingly, 18% of those people who said that their children weren't immunised, named antipathy to immunisation, or concern about side-effects, so it would seem that these sort of factors are starting to bite in the community.

Norman Swan: So for a doctor in the surgery, or indeed a government deciding a health promotion campaign, what's the solution? What you're suggesting is that giving facts could actually sometimes make it worse.

Simon Chapman: It is important for the medical profession and public health people to put out reliable, understandable, comprehensive information, that people can listen to, people can absorb, and people can sort of repeat to others in conversations, and start building up -

Norman Swan: But how do you get around this sense that you're still hiding something because you're in cahoots with Merck or Glaxo?

Simon Chapman: Well one of the recommendations that we've made in our report is that there ought to be a lot more effort put in by governments to throw wide open all the efforts which are under way to monitor the adverse reactions which do occur. Those ought to be accessible openly, they ought to be put on the World Wide Web for example, there ought to be transparency in all of these matters, because I think that could neutralise the accusation that there's a huge cover-up.

Norman Swan: And the one-to-one process between a doctor and his or her patient?

Simon Chapman: I think it's most important for doctors to acknowledge where parents are coming from in their concerns, not to trivialise them or to ridicule them or to treat the people as if they're simply simple-minded. But having done that, I think also to engage at the level of concern, I mean if the person believes that these things are witches' brews, to actually try and explore what it is that they understand that, and to try and meet those objections calmly, understandingly and so forth, rather than just be contemptuous of those sort of beliefs.

Norman Swan: Provocative but commonsense findings. Simon Chapman is Associate Professor of Public Health at the University of Sydney. The paper is in the current edition of The Australian and New Zealand Journal of Public Health.